Biopsychosocial Factors and Pain Hypervigilance Should Be Considered in the Interpretation of Disease Activity in Systemic Sclerosis.

Abstract

Objective: This study aimed to identify a pain phenotype associated with hypervigilance in systemic sclerosis (SSc) and evaluate possible variables that influence pain hypervigilance symptoms.

Methods: This cross-sectional, observational study included healthy controls (HCs) and SSc patients diagnosed with a score of 9 or higher according to the 2013 American College of Rheumatology-European League against Rheumatism classification criteria. The pain hypervigilance symptoms were evaluated using the central sensitization inventory (CSI), while disease activity was assessed using the European Scleroderma Research Group Activity Index (EScSG-AI). Patients were classified by CSI scores. Comparatives were done.

Results: A total of 51 SSc patients (92.2% female, mean age [50.54 years]) and 45 HCs (88.9% female, mean age [52.62]) were included. Education and monthly income were lower for SSc than HCs (p < 0.05). The CSI score ≥40 proportion was 56.9% in SSc and 15.6% in HCs (p < 0.001). Depression-Anxiety-Stress Scale (DASS-21), Epworth Sleepiness Scale (ESS), Global Pittsburgh Sleep Quality Index (PSQI), and EuroQol Five-Dimensional Three-Level Questionnaire (EQ-5D-3L) scores were higher in SSc than HCs (p < 0.05). By using multiple linear regression analysis to determine predictors of CSI score ≥40, the effective variable was EScSG-AI. In multivariate logistic regression analysis, educational level and global PSQI scores were factors associated with CSI score ≥40 in SSc.

Conclusions: CSI score was positively associated with depression, disease activity, stress, anxiety, and poor sleep quality, while it was negatively associated with education and economic status. Pain hypervigilance may affect organ involvement and functioning in SSc. Clinicians should examine its biopsychosocial components.